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T2-Weighted MRI Signal Intensity Ratio Predicts Intraoperative Intracranial Meningioma Consistency: A Retrospective
Ishan Shah1, David Gomez1, Kevin G Liu1
1Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
Neurosurgery
|February 12, 2026
Summary
Preoperative T2-weighted imaging (T2WI) can predict meningioma consistency. Higher tumor/cerebellar peduncle T2WI intensity (TCTI) ratios indicate softer tumors, aiding surgical planning.
Area of Science:
- Neurosurgery
- Radiology
- Oncology
Background:
- Meningioma consistency impacts clinical and surgical outcomes.
- Preoperative knowledge of meningioma consistency is crucial for surgical planning and decision-making.
Purpose of the Study:
- To investigate the association between intraoperative meningioma consistency and preoperative T2-weighted imaging (T2WI) and diffusion-weighted imaging.
- To determine if MRI can predict tumor hardness before surgery.
Main Methods:
- Prospective assignment of tumor consistency in 188 meningioma patients using a 5-point scale.
- Quantification of signal intensity using tumor/cerebellar peduncle T2WI intensity (TCTI) ratios.
- Measurement of mean and maximum signal intensity on T2WI and diffusion-weighted MRI sequences.
Main Results:
- Lower TCTI ratios correlated with higher-grade (4+5) meningiomas compared to grade 3 and grade 1+2 tumors.
- TCTI ratios were independent predictors of meningioma consistency.
- T2WI alone, using a TCTI ratio cutoff of 1.536, effectively differentiated grade 1+2 from grade 4+5 tumors with 75.0% sensitivity and 100% specificity.
Conclusions:
- The TCTI ratio derived from T2WI is significantly associated with intraoperative meningioma consistency.
- Higher TCTI ratios predict softer meningiomas.
- This MRI-based metric can enhance preoperative surgical planning and patient counseling.
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